Author: BPS Staff

By Brooke Schwartz, LMSW

As time goes on and you settle into your new routine, you may be thinking about finding a therapist for yourself or your child. Do you have questions or feel confused about where to begin? Here are some common teletherapy questions, answered:

What is teletherapy, anyway?

Teletherapy — sometimes referred to as video therapy, virtual therapy, or e-therapy — is the online delivery of therapy services. It involves meeting with a therapist just as you would in-person, except over video (or sometimes by phone).

Why would I start teletherapy right now?

There are a few reasons that might lead you to start teletherapy:

1. You’ve noticed new problems emerge. Staying at home brings with it a variety of new issues. Perhaps you’re experiencing a new pattern of overeating at night or are struggling to adjust to homeschooling your children. It’s entirely normal to be experiencing problems you may never have had to deal with until now. Teletherapy will help you manage these issues, and help you get from “surviving” to “thriving.”

2. You’ve noticed existing problems worsen. Maybe you’ve always been an anxious person, but until now it’s felt like something you could manage on your own. Now, perhaps every day is filled with worries about what the future holds, whether your loved ones will get sick, and how you can be sure you’ve actually washed your hands long enough to get rid of the germs. The current circumstances may have exacerbated issues you were already experiencing — ones that you were potentially even managing on your own.

3. You have more time on your hands to address problems that linger in the background. If you’re someone with more free time on your hands, you may be looking for new ways to keep yourself busy. For those who’ve said to themselves, “Sure, I’d go to therapy if I had the time for it,” now might be the time to explore your values and morals, or tackle that pesky phobia you’d rather do without.

4. You’re isolated and looking for some extra support. Social distancing can be lonely, and the relationship between therapist and client is just that — a relationship. Starting therapy is a great way to build or expand your support network and reduce your sense of loneliness.

What’s the first teletherapy session like?

Just as with in-person therapy, you’ll most likely meet your therapist for the first time during what’s called an “intake session.” The purpose of this session is for your therapist to assess and understand your current symptoms (that is, what brings you to therapy), the history and triggers for those symptoms, and how they interfere, if at all, in your life. Given the current context, it’s likely that when you meet your therapist they’ll check in about how you currently spend most days, where you’re located, and who — if anyone — you’re with. By the end of the intake session, you and your therapist will discuss their treatment recommendation, including what kind of therapy you’ll be doing together and how frequently you’ll meet. You’ll also have the opportunity to ask your therapist any questions you may have.

Is teletherapy just video-chatting with my therapist?

The short answer? Sort of. The longer answer is that most therapists are using HIPAA compliant telemedicine platforms such as Zoom, doxy.me, or VSee to conduct teletherapy sessions so that your privacy is protected. HIPAA, the Health Insurance Portability and Accountability Act of 1996, is a federal law that ensures the protection of patient health information. For a variety of reasons, you and your therapist may decide to use a platform that is not HIPAA compliant, such as FaceTime. If this is the case, your therapist will explain to you the risks associated with choosing not to use a HIPAA compliant platform.

What if we have technical issues?

While undesirable, technical issues — such as having spotty WiFi, losing battery on your computer, or running into problems with the platform you use — may happen. You can help prevent technical issues on your end by checking to make sure that you’re on strong WiFi (or have access to a hotspot before you begin your session) and that your device is fully charged. When you first get started with your therapist, you’ll likely discuss a back-up plan in case you run into technical problems. The most common and reliable back-up plan is often to speak on the phone.

Are there any upsides to doing teletherapy?

Absolutely! For one, your therapist will see you in your own environment. So if you’re struggling with over-eating during quarantine, you might show your therapist how your kitchen is organized and problem-solve together how to make certain food items less accessible or tempting. For kids doing teletherapy, being on video can even strengthen their relationship with their therapist — children love showing off their rooms and favorite games. Staff therapist Carrie Covell says, “My favorite aspect of teletherapy is getting to meet people’s pets. Animal cameos even come in handy when teaching DBT skills such as Distract and Self-Soothe!”

If my in-person sessions have been covered by insurance in the past, will teletherapy services still be covered?

Many insurance companies that don’t typically reimburse for telehealth therapy sessions are offering coverage during this time. Those with Medicare or Medicaid benefit from a “telehealth waiver” initiative, which allows clients to receive health services virtually. Many private insurance companies (including Aetna, Cigna, and BlueCross BlueShield) are following suit. Be sure to check with your insurance company about their updated policies regarding out-of-network reimbursement for telehealth claims. If your insurance company is denying you teletherapy coverage, you may consider filing an appeal.

How can I make the most out of my teletherapy sessions?

For one, set yourself up for your teletherapy session in a place where there are minimal distractions. This might mean going to a quiet part of your apartment or house away from others, turning your phone and computer on “do not disturb” mode, or making the video full-screen so that you’re not distracted by push notifications. If possible, choose a designated spot to use for teletherapy sessions so that you’re not trying to work out logistics (such as where to put your phone or computer) during the session. Use headphones if you’re worried about others in your home hearing your session — distance may not be possible in your environment, and using headphones will at least help prevent others from hearing your therapist speak to you.

Would I continue therapy once I go back to work (or school, etc.)?

Everyone is different! While many will want to continue with therapy in-person when the time comes, it’s possible that you don’t, particularly if you’re starting teletherapy for a problem that’s specific to being quarantined. If this is the case, and you and your therapist agree that continuing therapy isn’t necessary, you may decide together to stop. Keep in mind that the decision to stop or continue therapy doesn’t have to be one you make alone — your therapist is there to help support you in making this decision!

Teletherapy may seem daunting for those who have never been in therapy before, or even for those who are used to seeing their therapist in-person. Here’s hoping these answers give you some clarity on the process.

If you’re interested in starting therapy at Behavioral Psych Studio, contact us by calling 917-497-2760 or emailing info@mediumseagreen-swallow-947514.hostingersite.com!

Disclaimer

This site is for information only. It is not therapy. This blog is only for informational and educational purposes and should not be considered therapy or any form of treatment. We are not able to respond to specific questions or comments about personal situations, appropriate diagnosis or treatment, or otherwise, provide any clinical opinions. If you think you need immediate assistance, call your local emergency number.

For referral information about our services, please click here or see our contact page on our website.

By Brooke Schwartz, LMSW

In a previous blog, we discussed tips for managing your own coronavirus-related anxiety. Many people also have the task of helping their kids deal with a variety of difficult emotions right now. If you find yourself in this position, consider the following tips:

Maintain routines and have a schedule.

Knowing what’s coming next gives kids a sense of security and consistency. As much as possible, stick to routines that were in place before, such as bedtime and mealtime routines. Create daily or weekly schedules including both learning-related activities (e.g., remote learning or reading time) and relaxing activities (e.g., play time or movie night). Involve your child in creating the schedule to get them invested, and hang the schedule up somewhere where your child can see it.

Limit exposure to news.

While it can be important to stay up to date with the news, the language and images on the news and social media can be anxiety-inducing for both you and children. Consider turning off the TV during the day and adjusting your push notification settings so that you’re in control of when you and your child receive new information.

Share (basic) information and discuss what’s within their control.

It’s understandable that kids may have questions about coronavirus and how it’s affecting their lives. Keep your kids in the know by sharing age-appropriate factual information with them in as simple language as possible. In discussing the virus, direct the conversation to what your kids can do (for example, wash their hands for at least 20 seconds) to help them feel a sense of control. This illustration is one of many resources that aims to explain to kids what coronavirus is and how they can help keep themselves and loved ones safe.

Resist the urge to excessively reassure…

While a healthy dose of reassurance is okay (think: “We’re going to get through this”), be careful not to excessively reassure your child. Excessive reassurance — such as, “You’ll definitely be able to go to camp this summer,” and “Nothing’s going to happen to any of us” — may lead to unrealistic expectations, and might make it harder for your child to work through their emotions if the worst case scenario does happen. Excessive reassurance may also be experienced by children as invalidating, meaning that it suggests the child shouldn’t be feeling whatever they’re feeling.

…by sticking to validation.

Validating simply means communicating that something makes sense. When kids receive validation from their caregivers they’re more likely to feel heard and understood, and learn that it’s okay for them to experience emotions.

Example of a validating statement: “I can see how worried you are. It can be really overwhelming to feel so worried.”

Example of an invalidating statement: “There’s no need to worry. You’ll be okay, I promise.”

Identify new opportunities.

Your child may be focused on all the things they can’t do right now. Help them identify things they can do as a result of the current situation. If your child is disappointed that the tennis season ended early, organize a table tennis competition at home. If your child was involved in community service efforts that are being put on hold, come up with ways to give back to health professionals or neighbors. Highlight other new opportunities your child will get to experience, such as having sleepovers in their sibling’s room or getting to see what their pet really does while they’re normally at school!

Model your own emotion regulation.

It’s okay to be emotional and vulnerable in front of kids — in fact, it can even be beneficial. When kids observe caregivers coping with difficult emotions, they learn what to do when their own show up. So if you’re feeling anxious, instead of trying to manage it behind closed doors, you may share with your child something like, “You know, I’ve been feeling really anxious today and I think it might be helpful to take a few deep breaths. I’m going to try that to see if I can feel a little calmer.” Then, when you notice your child attempting to regulate their own emotions, praise their efforts!

Help your child externalize anxiety.

One way to help kids manage their anxiety is by externalizing, which involves assigning the anxiety to a character or concrete image. Maybe anxiety shows up as a “worry monster” who’s always frazzled and is followed around by a raining cloud. Discuss what happens when the worry monster shows up and what tools your child could use to battle the monster when it does. Could your child imagine the monster tripping and falling? Could they say something back to the monster? Externalizing is a great way to teach kids to separate from their emotions and use problem-solving strategies when they arise.

Designate worry time.

For children whose days seemed to be consumed by worrying, consider designating a few minutes of worry time per day. Choose a time, place, and length of time (for example, at 4PM in the living room for 10 minutes), but be sure not to schedule it too close to bedtime. Encourage your child to write down a few words to describe their worry thought on a piece of paper as they come up throughout the day (you may even turn this into an activity by designing a “worry box” with your child to put the worry thoughts in!). Every time your child writes down a worry thought, instruct them to refocus their attention to something happening in the present moment, for example by using any of their five senses. When the time comes, revisit the worry thoughts — but only for the designated amount of time!

Just like adults, kids may also be experiencing a spike in anxiety right now. Not only can trying out these tips help kids manage current worries — it may also lead to the development of lifelong emotion regulation skills!

Disclaimer

This site is for information only. It is not therapy. This blog is only for informational and educational purposes and should not be considered therapy or any form of treatment. We are not able to respond to specific questions or comments about personal situations, appropriate diagnosis or treatment, or otherwise, provide any clinical opinions. If you think you need immediate assistance, call your local emergency number.

For referral information about our services, please click here or see our contact page on our website.

By Brooke Schwartz, LMSW

You may be finding it difficult to avoid conversations about the coronavirus disease. It’s in the news, on social media, and a common topic of personal and professional conversations. While everyone responds differently to major global events and crises, it’s normal to experience an onset of anxiety or a spike in pre-existing symptoms.

While anxiety is occasionally motivating and allows us to get important tasks done, it sometimes rises to a level that interferes with daily life and may even feel paralyzing. If you’re looking for ways to manage your coronavirus-related anxiety, look no further!

Acknowledge the anxiety.

Have you ever noticed that when you’re anxious you’re also crankier? Or perhaps when you’re anxious you’re slower to respond to texts? Anxiety looks different depending on the person and the context, which can make it challenging to realize that it’s shown up at all. The problem is that emotions (like anxiety) are difficult to address if we don’t know that they’re happening, or if we chalk them up to something else (like “just not feeling great”). Acknowledge that you’re feeling anxious without trying to suppress the anxiety or attach to it. Just take note that the emotion has shown up by telling yourself, “I notice that I’m feeling anxious right now.”

Validate yourself (and others).

Validating is, in short, communicating that something makes sense. Why do this? For one, because it feels good. It also makes problem-solving more possible and increases a sense of support. Here’s an example of a self-validating statement: “It makes sense that I’m anxious about my risk given that I have autoimmune issues.” Is your friend calling you in a panic? Validate them by saying, “I can see how fearful you are right now.”

Be aware of anxiety’s tendency to generalize.

You might find that your coronavirus-related anxiety is expanding to anxiety about other areas of your life. Be mindful of what you’re feeling anxious about. If you become anxious while cooking dinner, check in with yourself by asking, “Am I anxious about cooking this just right, or is it that I’m feeling anxious after watching the news?” Experiencing persistent anxiety about coronavirus may make you more vulnerable to feeling anxious in other areas of your life — even areas you once found solace in!

Differentiate between problem-solving and anxious rumination.

As mentioned, anxiety can be motivating in that it moves us to problem-solve and get important tasks done. For example, anxiety about keeping your hands clean may motivate you to buy more soap when you run out. However, there’s a difference between effective and doable problem-solving (as in this example) and anxious rumination. Whereas problem-solving may alleviate some anxiety and generate a feeling of progress, anxious rumination often leaves us feeling worse. It involves catastrophizing, feeling overwhelmed and dreadful, getting stuck in “what-ifs,” seeking out reassurance, and believing everything needs to be solved right now. If you’re experiencing anxious rumination, transition into problem-solving mode by asking yourself, “What can I reasonably do right now to address this issue?” The answer may be going out to buy soap, or it might be turning on a movie to distract from the anxiety.

Take intentional breaks from the news and social media.

Imagine you’re at home preparing for a big presentation at work tomorrow and every single one of your hundreds of colleagues is texting you, “Don’t forget the presentation tomorrow. It better be good!” Constant reminders about our anxiety only serve to maintain it. When it comes to coronavirus-related anxiety, one solution is decreasing our exposure to reminders about it. Schedule time to turn the TV off, remove push notifications for the news on your phone, and even designate electronic-free times during the day. When you do look at the news and social media, make sure you’re looking at reputable sources that you expect will provide you with accurate information.

It can be much easier to cope with negative events and emotions when they’re balanced with positive experiences. Read the long book you’ve never gotten around to. Take up calligraphy. Do a large puzzle. If you’re cooking dinner, make a plate for your elderly neighbor. Mail a letter to a family member across the country to give them an unexpected surprise. Do something that makes you feel happy and purposeful to combat feelings of anxiety and helplessness.

Create a schedule or routine for yourself.

Many people experience anxiety when their regular schedule or routine is disrupted. If you’re working or studying from home, create a schedule or routine that fits your current situation. Wake up and go to sleep at consistent times. Get dressed in the morning even if you’re not planning to go outside. Designate 11AM-11:30AM as “vacuum time.” Take care of your body by eating regular and healthy meals. Find creative ways to move your body, such as marching in place while watching TV or dancing to music while you clean. Continue to do the things you need to do for work, school, or your personal wellbeing. Procrastinating — as relieving as it may feel in the moment — only serves to fuel anxiety.

Connect with people.

Find ways of maintaining your social networks to keep a sense of normalcy and connectedness. FaceTime with friends, even if they’re just down the street.

Continue with existing mental health treatment, if possible.

Check with your provider about your options for continuing treatment during this time. Many therapists will offer teletherapy (therapy via video or phone). Consider reaching out to your insurance company to see if they will reimburse for teletherapy services. If they haven’t in the past, it may be worth asking if they are making exceptions given the current circumstances.

Here’s to hoping you feel more confident in managing your anxiety as you navigate the current circumstances!

Disclaimer

This site is for information only. It is not therapy. This blog is only for informational and educational purposes and should not be considered therapy or any form of treatment. We are not able to respond to specific questions or comments about personal situations, appropriate diagnosis or treatment, or otherwise, provide any clinical opinions. If you think you need immediate assistance, call your local emergency number.

For referral information about our services, please click here or see our contact page on our website.

By Brooke Schwartz, LMSW

Think about the last time you were angry — like, really angry. You might be thinking of the time you waited at a coffee shop for someone who never showed, when you arrived at the airport only to learn that your flight was cancelled, or when someone cut you off on the road and almost caused a car crash.

Experiencing anger is a natural part of being human. It’s a universal emotion, one that shows up frequently and at different levels of intensity. So what if you found out that there’s more to anger than meets the eye?

Imagine you’re in the situation described above — you’re sitting at a coffee shop on a Monday afternoon, hoping no one at work realizes you snuck out a few hours early. Your best friend arranged for you to meet with her colleague, a top executive at their company, for coffee to discuss a position that just opened up which you happen to be perfectly qualified for. You tell yourself that leaving work early is worth the risk — after all, you’re miserable in your current job. You can hardly wait!

It’s ten minutes past the hour and you think they must be running behind. But as ten minutes turn into fifteen (and then twenty and thirty), you become frustrated. You ask yourself, “What kind of person doesn’t show to a meeting without sending an email first?” Your jaw clenches. You think, “This is a sign from the universe that I’m destined to be unhappy.” Your fists tighten. You are angry.

But that’s probably not all. What many don’t know about anger is that it’s often experienced in response to other emotions.

All emotions can be thought of as primary or secondary. Whereas primary emotions are our direct reactions to a situation, secondary emotions are our responses to those reactions.

Primary emotions are what you first feel when you encounter a situation or event. The primary emotions that may have shown up in the above situation may include:

• Disappointment that the meeting wouldn’t take place

• Sadness that you have to continue in your current position

• Fear that you won’t find another job

• Guilty that you left work early

Secondary emotions are what you feel about that initial emotional response (or responses). They may involve judgments or interpretations that go beyond the actual facts of the situation, and they can be quick to show up, making it difficult to identify what’s actually underneath them. Examples of secondary emotions that could mask underlying emotions in this situation may include:

• Anger (in response to feeling disappointment, sadness, and fear)

…at yourself for getting your hopes up about the job

…at the world for never cutting you a break

…at the other person for not showing up

• Insecurity (in response to feeling disappointment) that the person you were supposed to meet perhaps thought you were underqualified or not worth their time

• Paranoia (in response to feeling guilt) that someone from work may walk into the coffee shop and think you were blowing off work

• You don’t even know what you’re really feeling. In these instances, your body and brain may default to anger. This is often the case for people who feel like they’re ‘always angry’.

• You want to feel in control. There’s no denying that it’s uncomfortable, undesirable, painful, and even paralyzing at times to sit in certain emotions, such as sadness and fear. You may (oftentimes mistakenly) think you’ll be more productive or motivated when you experience anger — for example, by having an “I’ll show them what they’re missing” mentality in this kind of situation.

• You’re insecure about feeling what you really feel. You may have learned that it’s not acceptable to experience or express certain emotions, such as sadness or fear, in situations like these. Hearing statements like, “Don’t be sad —there will be other opportunities!” or, “Just pull yourself up by your bootstraps” in this kind of situation may lead you to gravitate away from your primary emotions. Maybe you’ve even been punished in the past (e.g., called sensitive or weak) when you’ve been vulnerable and expressed your true emotions.

The problem with focusing only on secondary emotions like anger — and not identifying or paying attention to primary emotions, is that they mask your underlying — true emotions which tell you valuable information about what your actual needs are. If you can’t identify and describe your true emotions, you’ll have difficulty changing them and they might linger longer than they would if you addressed them head-on.

Stay tuned for our next blog where we’ll discuss how to figure out whether anger is a primary or secondary emotion, and what to do about it when it shows up!

Disclaimer

This site is for information only. It is not therapy. This blog is only for informational and educational purposes and should not be considered therapy or any form of treatment. We are not able to respond to specific questions or comments about personal situations, appropriate diagnosis or treatment, or otherwise, provide any clinical opinions. If you think you need immediate assistance, call your local emergency number.

For referral information about our services, please click here or see our contact page on our website.

By Brooke Schwartz, LMSW

As January blends into February, you may feel farther and farther away from the motivation that led you to set your New Year’s Resolution. This happens to the best of us — we consider the new year the perfect opportunity to work toward a goal in the hopes that our lives will improve in some way, only to eventually abandon (or forget about) it.

Achieving goals is tricky for several reasons, one being that developing a habit — arguably the goal of working toward a goal — has been found to take some time. This suggests that the start-and-stop nature of New Year’s Resolutions isn’t doing us any favors in the long-run.

So what’s the secret to achieving your goals (regardless of the time of year)? Many know already that goals are supposed to be “SMART” — that is, they should be:

• Specific (rather than vague)

• Measurable in that certain criteria measures progress

• Achievable meaning that it’s possible to reach

• Relevant to your values and other life goals

• Time-bound meaning that at a predetermined time you’ll be able to identify whether you have or have not met the goal

The “SMART” acronym is a helpful starting place for any goal-setter. That being said, there are several more steps you can take to set yourself up for success when it comes to achieving your goals.

Imagine you notice that every time you write in your journal, you feel less anxious and make clearer and more definitive life decisions. You decide that you want to set a “SMART” goal to write in your journal once per day for 10 minutes for the next 6 months. You might then wonder, what can I actually do to achieve this goal? Consider the following tips:

• Size up. Goals often feel daunting. Working your way up to your goal — for example, by starting to writing for just one minute and adding another minute per day until you reach 10 — can help you build a sense of mastery that keeps you motivated. You may also think about what smaller steps need to get done in order to even begin to work toward your goal, such as buying a notebook and cleaning off your desk.

• Troubleshoot. Plan ahead of time for barriers that might get in the way of achieving your goal. Barriers are often logistical (not having access to what you need) or motivational (lacking the drive or inspiration). One way to address the logistical barrier of not having materials to journal with may be to put a small notebook and pen in the bag you regularly use so that you can write on-the-go. To anticipate motivational barriers — for example, thoughts like “I should really spend this time answering emails instead of journaling” — you may keep a list in your phone’s notepad of all the reasons you set this goal in the first place, or a list of statements that challenge your unmotivated mind (“I know you think you could be answering emails right now, and you always feel less anxious about emails after you’ve journaled”).

• Remind yourself regularly. Find ways to regularly remind yourself of your goal. This may mean setting a daily reminder on your phone, leaving post-its throughout your apartment, or working toward your goal alongside a friend or family member who will hold you accountable (and vice versa!).

• Keep tabs on your progress… Set regular check-in times for yourself (weekly, monthly, quarterly — whatever you think will work best for you) to help you follow through on your goals. This may be something you do mentally by asking yourself, “How have I been doing with this goal?” or you may find it helpful to keep a visual tracker of your progress. Consider putting a smiley face on every day of your calendar that you write in your journal for 10 minutes. Then when it’s time to check in with yourself, you’ll have a visual representation of your progress.

• …and reward yourself along the way. Research shows that when rewards are given while working toward a goal (rather than waiting until the goal is fully achieved), people experience more motivation. So alongside keeping tabs on your progress, schedule rewards for yourself for the steps you take toward meeting your goal. You may decide that, to start, you’d like to write in your journal for 10 minutes per day at least 4 times per week and that — if you’re able to do this — every Sunday you’ll reward yourself by ordering takeout rather than cooking. Keep in mind that in order for rewards to be motivating, they have to be something you actually want to work toward.

• Expect imperfection and be open to being flexible. Achieving our goals isn’t easy. Treating yourself with compassion will help you maintain motivation, even when you feel like you’re failing to meet your goals. Keep in mind that goals can (and often need to!) be revised, and that you’re setting yourself up for more success if you reframe “failures” as “opportunities” to continue working toward your goals.

Setting and working toward goals doesn’t have to end when the excitement of the New Year fades. Whatever you’re working toward, we’re wishing you success and hoping that these tips will help you along the way!

Disclaimer

This site is for information only. It is not therapy. This blog is only for informational and educational purposes and should not be considered therapy or any form of treatment. We are not able to respond to specific questions or comments about personal situations, appropriate diagnosis or treatment, or otherwise, provide any clinical opinions. If you think you need immediate assistance, call your local emergency number.

For referral information about our services, please click here or see our contact page on our website.

By Brooke Schwartz, LMSW

If the mere mention of the holiday season brings about feelings of anxiety, uncertainty, and dread, you’re not alone. Sure, the holidays are marketed as a cherished time to give, receive, reflect, and be with loved ones. But for many, this couldn’t be farther from reality. Instead, you may find that the holiday season is actually the time of year you struggle the most with joy, love, and happiness.

The winter holidays can be tough for a number of reasons. Perhaps you don’t get the end-of-year bonus you anticipated. Maybe your uncle tends to bring up politics— and not in the civil way — after a few drinks. It could be that your relationship ends right before you’re going to introduce your partner to your family at a holiday dinner.

Intense and unwanted emotions don’t take a vacation like many of us do this time of year. If anything, they might even be overworked and unrelenting. What’s more, most people tend to be reactive to their emotions, meaning that they try to deal with them after they’ve already arisen. As it happens, putting the emotional labor in ahead of time can help decrease the likelihood that you suffer from and act on unwanted emotions. So this holiday season, give yourself the gift of preventing painful and pesky emotions by practicing a skill called Coping Ahead.

Coping ahead involves thinking ahead of time about which situations you anticipate will be most difficult to tolerate this holiday season and imagining yourself dealing with them effectively. Cope ahead by going through the following steps (either in your mind or by writing it out):

1. Describe the situation and the emotion.

What exactly do you anticipate experiencing? Try to be as factual as possible (thinking, “Uncle Joe is going to ruin the night” will only serve to fuel your unwanted emotions). You may think, “Uncle Joe is going to make a comment about politics. I will probably notice my heart rate increasing and myself feeling frustrated and anxious.”

2. Name the urges.

Emotions tend to inspire urges to act — oftentimes in ways that are not in line with our values and make the situation worse. Think about what behaviors of yours are associated with the emotion you’ve identified. You may notice that when you feel frustrated and anxious with Uncle Joe, you have the urge to make comments under your breath and ask him questions such as, “How could you possibly believe that?”

3. Identify coping skills.

Ask yourself, “How can I cope with the emotion to prevent myself from acting on the urge?” Perhaps when you hear Uncle Joe say something that frustrates you, you’ll leave the room, breathe deeply, or think encouraging thoughts such as “I can handle this.” Don’t be afraid to creative here! Maybe every time Uncle Joe speaks, you see how long you can drink from your glass of water, or you repeat what he’s said in your mind in your favorite cartoon character’s voice. The goal is to do something that either decreases the intensity of your emotion or makes it harder to act on your urges.

4. Imagine the situation.

Visualize the scenario in your mind as vividly as possible, making sure you can see yourself in the situation. Describe the scenario in the present tense — “Uncle Joe says _____________. My heart races and my jaw clenches. There’s a pit in my stomach and I feel frustrated and anxious.”

5. Rehearse yourself coping effectively.

What would it look like for you to cope effectively in that moment? Imagine exactly what you would (or would not) do. What do you say? What do you not say? What do you or don’t you think? Imagine new problems arising. For example, what if you’ve let an under-the-breath comment slip out at the dinner table? Or what if your favorite cousin unexpectedly agrees with Uncle Joe? Think through how you’ll deal with different iterations of the situation, including the worst possible case scenario you can imagine.

6. Repeat, as needed.

Going through your cope ahead plan multiple times will help you feel more prepared to cope in the situation and equipped with tools to handle other situations that may arise unexpectedly.

In practicing coping ahead by going through these steps, you’ll decrease the likelihood that you experience negative and unwanted emotions, and increase your ability to manage them if they do arise. Keep in mind that coping ahead doesn’t get rid of emotions altogether (that wouldn’t be desirable, anyway!) — but it can help you reduce the amount of suffering you experience as a result of them.

Disclaimer

This site is for information only. It is not therapy. This blog is only for informational and educational purposes and should not be considered therapy or any form of treatment. We are not able to respond to specific questions or comments about personal situations, appropriate diagnosis or treatment, or otherwise, provide any clinical opinions. If you think you need immediate assistance, call your local emergency number.

For referral information about our services, please click here or see our contact page on our website.

By Brooke Schwartz, LMSW

Here’s the situation: Allie’s on vacation in Prague for the holidays after saving up and planning for the trip. She’s excited for all the fun she’s going to have and proud of her months of saving. But on the first day of her trip, she learns that her grandmother, who’s been sick for months, has died. Allie feels completely overwhelmed — her head is spinning, and she thinks she must be the worst granddaughter in the world to travel when her grandmother was unwell. How does she manage all of this?

Some people may choose to cope with a situation like this one in ways that actually make things worse (e.g., recklessly spending money, overeating, or binge drinking). And to their credit, these ways of coping sometimes do help reduce really intense emotions. They’re distractions from the pain, oftentimes numbing or dulling it — but only in the short-term, as the relief that they bring rarely lasts. What’s more, these ways of coping are also often unproductive, unsafe, and chock full of unpleasant consequences (anyone who’s experienced a hangover can vouch for that!).

While coping with emotions in a healthy and safe way isn’t always a simple task, it is indeed possible. Keep in mind that coping means just that: regulating, moderating, controlling, and downsizing — it does not mean getting rid of difficult emotions altogether (even though we may want to).

So, what’s Allie to do? It’s incredibly difficult to manage an emotion if you don’t know which one it is, or when you have to manage many at once. Try going through the following steps when a difficult emotion arises:

1. Just notice.

Observe your thoughts, feelings, and bodily sensations. This will help you slow down and take a deep breath. Allie could start by making statements such as, “I notice my heart is racing and I’m having the thought, ‘I wish this would all go away.’”

2. Name it to tame it.

Identifying what you’re feeling can be quite grounding. Allie can ask herself, “Am I feeling (insert emotion here)?” over and over, inserting a new emotion in the blank every time. She may eventually identify that she’s feeling devastated about the death, guilty for traveling when her grandmother was sick, and confused about whether to cut her trip short to attend the funeral.

3. Ask “Why?”

Consider why the emotion has shown up. While they can be pesky and painful at times, emotions actually do a lot for us:

• Emotions motivate and organize us for action. Allie’s sadness, guilt, and confusion will likely move her to make a decision about whether to end her trip early to attend the funeral. In the long-term, these emotions may lead Allie to think about her relationships, values, and priorities.

• Emotions communicate to (and influence) others. Allie learns about her grandmother’s death on a phone call with her parents. She begins crying and says, “I don’t know what to do.” These behaviors communicate to her parents that she is sad and confused. Based on this communication, her parents may console her or offer her advice — even if Allie hadn’t intended to communicate her emotions or influence their behavior.

• Emotions communicate to ourselves. Allie’s emotions prompt her to look inward and consider what she needs in the moment. Her sadness may indicate that she doesn’t feel up to going to a museum like she had planned — or maybe the sadness may indicate that what’s going to help her get through the rest of the day is in fact going to the museum as an intentional distraction from her intense emotions.

4. Validate, validate, validate.

Let go of beliefs that there are right and wrong ways to feel about or act in a situation. Allie can practice being nonjudgmental of her emotions, and even validate their existence by making statements such as, “It makes sense that I’m feeling confused,” or “Anyone in my situation would feel this way.”

Knowing what you’re experiencing and why are helpful first steps in changing or tolerating difficult emotions. Once you take this step, you can implement coping skills, which are shown to help people in situations like Allie’s cope effectively with difficult emotions and reduce their overall suffering. Stay tuned for future blogs — we’ll be discussing more ways to cope with intense and difficult emotions!

Disclaimer

This site is for information only. It is not therapy. This blog is only for informational and educational purposes and should not be considered therapy or any form of treatment. We are not able to respond to specific questions or comments about personal situations, appropriate diagnosis or treatment, or otherwise, provide any clinical opinions. If you think you need immediate assistance, call your local emergency number.

For referral information about our services, please click here or see our contact page on our website.

By Brooke Schwartz, LMSW

Last year, Lady Gaga co-authored an op-ed for The Guardian highlighting the devastating and deadly effects of stigma against mental illness. She begins the article with a shocking statistic: by the time you finish reading her article, at least six people will have killed themselves around the world. “Suicide,” as Lady Gaga explains, “is the most extreme and visible symptom of the larger mental health emergency we are so far failing to adequately address.”

Calling this an emergency is no understatement — in 2017, suicide was the second leading cause of death among people between 10 and 34 years old. And suicide is only one piece of the puzzle. About 1 in 5 people in the United States live with a mental health condition (that’s around 60 million people) while less than half of them receive mental health services. Despite the fact that treatments have been (and continue to be) developed and well-researched, people are still struggling to reach out for help.

Why is this the case? Lady Gaga says it well: “Stigma, fear and lack of understanding compound the suffering of those affected [with mental illness] and prevent the bold action that is so desperately needed and so long overdue.”

Lady Gaga’s not the only celebrity to speak out about stigma as a barrier to mental health treatment. A few months ago, upon receiving the 2019 McLean Award for Mental Health Advocacy, Selena Gomez reflected, “I have feared being misunderstood and judged” for having experienced mental illness.

Stigma takes on many faces. Some people feel stigmatized by their family members and communities when they reveal their mental health conditions or express a desire to seek treatment. Others self-stigmatize in response to experiencing shame — shame about not being able to resolve their problems themselves and needing help at all. For some, this leads to a belief that one is deserving of or at fault for their mental health issues.

Not only do Lady Gaga and Selena Gomez share frustration about the role stigma plays in getting help; they’ve also both received mental health treatment in the form of Dialectical Behavior Therapy (DBT). Each has shared in the media the impact DBT’s had in their lives.

Originally developed to treat chronically suicidal individuals diagnosed with Borderline Personality Disorder, DBT is a treatment that has evolved into so much more. Over time, research has shown that DBT is an effective treatment for people experiencing a wide variety of symptoms and mental health conditions including anxiety, depression, non-suicidal self-harm, eating disorders, and substance abuse, among others. It’s a quality treatment that helps a wide range of people.

When it comes to seeking out and accessing DBT, stigma is certainly a barrier. It’s hard to admit you need help. It’s challenging to know whether the therapist you reach out to will actually help you. Sometimes problems seem so overwhelming you just don’t know where to start. Many believe DBT won’t help them. Some have done DBT before and think doing it again can’t possibly be worthwhile. There are hundreds of reasons not to seek out treatments (such as DBT) for mental health conditions.

We can’t let stigma be one of them. As Lady Gaga writes, we need to treat those facing mental health conditions with the compassion we would offer to people with physical illnesses or injuries — we must stop ostracizing, blaming, and condemning. This extends to how we treat ourselves. We can work to reduce stigma by treating ourselves with compassion and getting ourselves the help we want and need.

If you don’t know where to begin, consider whether any of the following might help you get started:

• Contact the behavioral health department at your insurance company to find out more about your coverage.

• Ask your primary care doctor (or your child’s pediatrician if the treatment is for your child) for a referral for a licensed mental health professional.

• Speak to a trusted family member or friend to see if they have a referral.

• Research the mental health services offered by your university or employer.

If you’re looking for a DBT therapist in particular, this website can direct you to certified DBT clinicians in your city. This one lists every clinician who has gone through intensive training in DBT. If you live in the greater New York City area, Behavioral Psych Studio provides DBT and other evidence-based treatments. Reach out to 917-497-2760 or info@mediumseagreen-swallow-947514.hostingersite.com for more information.

Disclaimer

This site is for information only. It is not therapy. This blog is only for informational and educational purposes and should not be considered therapy or any form of treatment. We are not able to respond to specific questions or comments about personal situations, appropriate diagnosis or treatment, or otherwise, provide any clinical opinions. If you think you need immediate assistance, call your local emergency number.

For referral information about our services, please click here or see our contact page on our website.

By Brooke Schwartz, LMSW and Stephanie Dowd, PsyD

In past blog posts, we’ve discussed both what emotion dysregulation is and what it looks like in children. Need a refresher? Emotion dysregulation can be defined as the inability to regularly use healthy strategies to diffuse or control negative emotions.

It may not come as a surprise that romantic relationships are affected by how people control (and don’t control) their emotions. Many find that it’s difficult to adapt to their partner’s emotional reactions and that their relationship suffers because of it. And research supports this — couples that struggle with problems related to emotion regulation often experience lower relational satisfaction as well as lower intimacy levels.

What does emotion dysregulation look like in couples? While it varies couple-to-couple, some examples of behaviors include:

• Reactive and often impulsive behavior. This may involve making quick decisions, such suddenly going out of town when angry at a partner rather than confronting the issue, or threatening to hurt yourself in the midst of an argument.

• Either attacking or withdrawing in the relationship (or a combination of both). Attacking may involve violence or aggression, either physical (such as grabbing or hitting) or verbal (such as name-calling or yelling). Withdrawing may look like feeling so heated during a conversation that you just stop talking or walk out of the room.

• Frequent misunderstandings that are difficult to recover from. This may mean that, after a disagreement, it takes a long time to get “back to normal.” For example, if there’s a disagreement at the beginning of a meal, it feels like the entire meal is bound to be stressful and unpleasant.

• Extreme thinking. For example, frequently using the words “always” and “never” during arguments, or making general blanket statements such as, “You don’t care. You never have.”

Practice relational mindfulness.

• Mindfulness is practicing being present in the moment without judgment.

• It’s unlikely that you’ll be able to manage your emotions if you’re not aware that they’re escalating in the first place. So first, practice simply noticing and then describing your thoughts and emotions nonjudgmentally (e.g., “I feel my heart racing”). Try not to jump to any judgments such as, “They’re such a jerk!”

• Then, notice, observe, and describe only what you can observe about your partner (e.g. “They’re speaking. Now they’re looking down at their feet.”). Being mindful of your partner means you’re not attaching any judgments, interpretations, or inferences (e.g., “They’re not listening,” “They don’t care,” “They always do this”) to what you observe.

• Why practice relational mindfulness? It helps slow down your emotions and prevent them from getting out of control.

Validate the emotions, wants, and opinions of yourself and your partner.

• Validating is, in short, communicating to yourself or someone else that what they are thinking, feeling, or doing makes sense. “I can see how upset you are” and “I can understand why this angers you because this has happened before” are both examples of validating statements.

• You might have to give up being right in favor of getting along. Ask yourself: is it more important to be right or happy in this relationship? Keep in mind that it’s typically more important to be effective in the relationship (for example, by validating your partner) than to be right.

• Why validate your partner? Validating is a way of showing your partner that they are heard, which is one of the most powerful ways to reduce intense emotions in a couple.

Distinguish between your primary and secondary emotions.

• Primary emotions are universal responses to situations in life, such as sadness when a loved one dies or disappointment when you’re on the losing team in a game.

• Secondary emotions are reactions to primary emotions. Sometimes primary emotions happen so quickly that we don’t notice they’ve happened at all, and we jump to secondary emotions. For example, if your partner leaves in the middle of a heated conversation, you may respond with anger (often a secondary emotion), which could be a response to fear (a primary emotion) that your relationship is ending.

• Noticing your initial or primary emotions will help you get at the heart of the problem and address it head on. It will also help you avoid expressing unhelpful secondary emotions.

Increase pleasant (or even neutral) time together.

• It may seem impossible increase positive time together as a couple if you’re constantly arguing. However, if you can start with at least spending neutral time together, it may help cut down on the negative feelings you have about one another.

• Practice being in a room or the same car together — even if you’re not speaking. When it feels manageable, practice increasing shared pleasant activities (for example, doing something you both enjoy together). This can help build a sense of connection between you.

Consider couples therapy.

• It’s difficult to manage extreme emotions in a relationship. For those who need or want more support, there are resources available. In Dialectical Behavior Therapy (DBT) for couples, therapy goals include reducing negative patterns in the relationship and creating more helpful, constructive ways of interacting.

Disclaimer

This site is for information only. It is not therapy. This blog is only for informational and educational purposes and should not be considered therapy or any form of treatment. We are not able to respond to specific questions or comments about personal situations, appropriate diagnosis or treatment, or otherwise, provide any clinical opinions. If you think you need immediate assistance, call your local emergency number.

For referral information about our services, please click here or see our contact page on our website.